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Sustaining the Menafrivac Gains in Africa

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Sustaining the Menafrivac Gains in Africa Sustaining the MenAfriVac gains in Africa The MVP Closure Conference – Ending and New Beginnings Addis Ababa – 22-25 February 2016 Imran Mirza – UNICEF PD; Marie Thérèse Guigui – UNICEF WCARO; R. Kezaala – UNICEF PD Outline • Trends in meningitis incidence in the “Belt countries” and implications for immunization measures • Return on investments (ROI) • Sustaining the gains • Opportunities to strengthen routine immunization • Way forward; UNICEF comparative advantages When the situation changes….. Success doesn't come without challenges Confirmed cases 2000 1500 Men C 1000 500 Men W135 MenA 0 2009 2010 2011 2012 2013 2014 2015 Economic costs: estimated Meningitis CoC and per capita health expenditure in meningitis belt - 2013 Uganda Togo Tanzania Sudan South Sudan Meningitis cost of care per Senegal case - 2012 Rwanda Nigeria Niger Mauritania Burkina Faso: $ 116 Mali Kenya Ghana: $ 101 Guinea-Bissau Guinea Guinea: $ 43 Ghana Gambia, The Ethiopia Kenya: $ 246 Eritrea Cote d'Ivoire Nigeria: $ 99 Congo, Dem. Chad Uganda: $ 313 Central African Cameroon Burundi Burkina Faso Benin http://dx.doi.org/10.1016/j.vaccine.2014.11.061 0 20 40 60 80 100 120 140 USD Return on Investment: estimated economic benefits Burkina Faso Globally • reduction of disease burden • saving 378,000 lives • avoiding 673,000 cases of illness • saving 63,000 children from meningitis disability • $9 billion of costs averted between 2011 and 2020 Anaïs Colombini et al. Clin Infect Dis. 2015;61:S473-S482 HEALTH AFFAIRS 30, NO. 6 (2011): 1021–1028 How to sustain the gains during the transition period before availability of multivalent conjugate vaccine ? Population at risk of serogroup Future birth cohorts to be A epidemics protected protected through routine 2015 2016 2017 2018 2019 2020 2021 2022 Multivalent meningococcal conjugate vaccine Modeling: countdown to the next epidemic Comparison of strategies A-D hTp://www.who.int/immunizaon/sage/meeZngs/2014/october/presentaons_background_docs/en/ Karachaliou A, Conlan AJK, Preziosi MP and TroerC. Modelling long-term vaccinaon strategies with MenAfriVac® in the African meningiZs belt. Clinical InfecZous Diseases 2015; 61(Suppl.5): S594-600. Challenges in MenafriVac introductions into Routine Immunization programs HPV & IPV, +41% 45.59 MR for RV, +14% 32.66 PCV, +221% 28.59 Hib (Penta), +767% 11.43 HepB, +127% 0.67 1.28 WHO routine immunization summary tables; Gavi; UNICEF Supply Division; MSF The Right Shot 2nd ed. Challenges in MenAfriVac introductions into Routine Immunization programs - 2 Projected introductions in 2016 Proposed MCV1 * MCV2 * Country schedule (2014) (2014) Burkina Faso 15m 88% 17% CAR 9m 49% Ghana 18m 92% 67% Mali 9m 80% Niger 9m 72% Sudan 9m 86% 61% * WUENIC coverage through routine program Challenges can become opportunities MCV1 coverage among poorest and richest wealth quantiles, in meningitis belt Benin Benin Burkina Faso Burkina Faso WHO recommends Burundi Burundi Cameroon Cameroon § 1 - dose schedule, at 9 – CAR CAR 18 months. Chad Chad Congo, DR Congo, DR § Routine immunisation Côte d'Ivoire Côte d'Ivoire can be co-administered Ethiopia Ethiopia Gambia Gambia with yellow fever, Ghana Ghana measles and rubella GuineaAround 5 million Guinea Guinea-Bissau Guinea-Bissau vaccines. Kenyaunvaccinated in Kenya Mali Mali Mauritania 2014 Mauritania Niger Niger Nigeria Nigeria Rwanda Rwanda Senegal Senegal Countries with highest Tanzania Tanzania unvaccinated children Togo Togo Uganda Uganda 0 10 20 30 40 50 60 70 80 90 100 MCV1 Coverage (%) Fostering wider use of MenAfrivac UNICEF’s support: GLOBAL; REGIONAL & COUNTRY levels to address immunization inequities • Identify children who suffer from immunization (coverage) inequities & characterize the social/gender/geographical reasons. • Promote the use of micro-plans that ensure every community is accounted for & receives immunization sessions appropriate to people served. • Promotion and cross fertilisation of innovative solutions (including new technologies) that help overcome problems of inequities. • Systems to monitor immunization status of disadvantaged communities • Advocacy for commitment & allocation of resources to reduce immunization inequities at the level they can be overcome: health centers & communities • Adequate and affordable vaccine supplies Synergies in MenAfriVac introduction at 15-18mo and the 2YL immunization platform Unvaccinated children - selected • A stronger platform for countries despite immunization vaccination: primary doses, policy among 12-23mo booster doses and second Country % missing* doses. • An opportunity to provide Burkina Faso 11 missed vaccines to children Ghana 40 and to improve overall coverage Mali 41 • Create opportunities to Niger 36 integrate with other health *mainly measles 1st dose interventions Info from cards only (DHS data) Issues and considerations from previous new vaccine introductions • Commonly undertaken NUVI activities: – Training of health workers – Social mobilization, launch ceremonies – Updating recording & reporting tools / home based records – Cold chain equipment procurement • Commonly left out: – Strategic planning of NUVI with ISS, CSO and HSS – Other funding sources e.g Global fund; H4+ Issues to consider • Health system: How can MenA introduction create synergies to support the health system? • Integrated service delivery: How can joint planning be improved to enhance integration? • Costs and financing: What are the actual costs of MenA vaccine introduction, including collateral costs? • Coverage equity: How can MenA introductions produce an opportunity to improve equity of access and health benefits? How to maintain population immunity & ensure epidemic response Multivalent meningococcal conjugate vaccine 2015 2016 2017 2018 2019 2020 2021 2022 Low risk of A epidemics Risk of epidemics by other serogroups remains Stockpile of vaccines covering non-A serogroups needed for outbreak control UNICEF epidemic response SOCIAL MOBILIZATION COMMUNITY ENGAGEMENT INNOVATIONS TRAINING OF HWs Bari mu tare da wani sabon mafari Lets start a new beginning together .
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